Srividya Budithi1, Richard Peevor1, David Pugh2, Emmanouil Papagiannakis3, Amanda Durman3, Nassera Banu4, Aderemi Alalade5, Simon Leeson1. 1. Department of Obstetrics and Gynecology, Ysbyty Gwynedd, Bangor, United Kingdom. 2. Department of Obstetrics and Gynecology, Royal Glamorgan Hospital, Llantrisant, United Kingdom. 3. DYSIS Medical, Edinburgh, United Kingdom. 4. Department of Obstetrics and Gynecology, Ysbyty Glan Clwyd, Boddelwyddan, United Kingdom. 5. Department of Obstetrics and Gynecology, Wrexham Maelor Hospital, Wrexham Maelor, United Kingdom.
Abstract
BACKGROUND: The diagnostic accuracy of colposcopy is poor for detecting precancerous cervical lesions. OBJECTIVES: We assessed the performance of colposcopy for identifying cervical intraepithelial neoplasia grade 2 or worse (CIN2+), before and after including a dynamic spectral imaging (DSI) map that quantifies and maps acetowhitening to assist subsequent biopsy of suspicious lesions. METHODS: Four hundred and twenty-five women were examined at a multi-center setting in Wales, of which 393 women were included in the final analysis. RESULTS: For all referrals, the sensitivity of conventional colposcopy for histologically confirmed CIN2+ was 51.5%, the specificity was 92.0%, the positive predictive value was 56.7%, and the negative predictive value (NPV) was 90.4%. With the incorporation of the DSI map in predicting CIN2+, these became 84.8, 61.5, 30.8, and 95.3% respectively. The increase of sensitivity was statistically significant (p < 0.001). For the 236 women having colposcopy after low-grade (LG) cytology, with the incorporation of DSI, the sensitivity for CIN2+ increased from 27.3 to 86.4% (p < 0.001) and the NPV from 92.6 to 97.8%. CONCLUSIONS: Colposcopy with DSI results in improved sensitivity to detect CIN2+ and maintains a high NPV for all referrals and especially for those with LG referral cytology.
BACKGROUND: The diagnostic accuracy of colposcopy is poor for detecting precancerous cervical lesions. OBJECTIVES: We assessed the performance of colposcopy for identifying cervical intraepithelial neoplasia grade 2 or worse (CIN2+), before and after including a dynamic spectral imaging (DSI) map that quantifies and maps acetowhitening to assist subsequent biopsy of suspicious lesions. METHODS: Four hundred and twenty-five women were examined at a multi-center setting in Wales, of which 393 women were included in the final analysis. RESULTS: For all referrals, the sensitivity of conventional colposcopy for histologically confirmed CIN2+ was 51.5%, the specificity was 92.0%, the positive predictive value was 56.7%, and the negative predictive value (NPV) was 90.4%. With the incorporation of the DSI map in predicting CIN2+, these became 84.8, 61.5, 30.8, and 95.3% respectively. The increase of sensitivity was statistically significant (p < 0.001). For the 236 women having colposcopy after low-grade (LG) cytology, with the incorporation of DSI, the sensitivity for CIN2+ increased from 27.3 to 86.4% (p < 0.001) and the NPV from 92.6 to 97.8%. CONCLUSIONS: Colposcopy with DSI results in improved sensitivity to detect CIN2+ and maintains a high NPV for all referrals and especially for those with LG referral cytology.